Volume 90  ·   Issue 23  ·  2010

In China, chronic hepatitis B virus (HBV) infection is the main cause of liver cirrhosis, end-stage liver disease and hepatocellular carcinoma (HCC). After liver cirrhosis enters decompensated stage from compensated stage to decompensated stage, liver function deteriorates rapidly, and various complications will appear, resulting in a large increase in the mortality rate of patients. A cohort study of 98 patients with liver cirrhosis with a median follow-up time of 4.3 years showed that the 5-year survival rate of compensated cirrhosis patients can reach 84%, while that of decompensated patients is only 14%; The median survival time of untreated compensated patients is 9 years, while that of decompensated patients is only 1.6 years [1]. The advent of nucleoside (acid) antiviral drugs has brought about the innovation of treatment concept. Besides the benefit of most patients with chronic hepatitis B (CHB), it has largely solved the problem of hepatitis B recurrence after transplantation, and also significantly improved the liver function of end-stage hepatitis B, delayed or avoided the need for liver transplantation, and even reduced the occurrence of HCC [2-3].

Objective To detect the level changes of plasma N-terminal B-type natriuretic peptide (NT-proBNP)and hish-sensitivity C-reactive protein(hs-CRP)in patients with heart failure(HF)and explore their clinical correlations and prognostic significances.Methods A total of 100 cases of HF patients were selected along with 20 age and gender-matched controls.The levels of NT-proBNP and hs-CRP were tested.Results The levels of NT-proBNP were significantly higher in HF patients than the controls.And the difference was statistically significant(P<0.01).In congestive HF patients,the elevating magnitude of plasma NT-proBNP level showed a significantly positive correlation with that of hs-CRP during the same period.Conclusion ①The level of NT-proBNP is significantly higher in HF patients.And it can be used as one of auxiliary diagnostic indieators.②The level of NT-proBNP in conjunction with hs-CRP can predict the prognosis of HF patients.

Objective The aim of this research is to observe whether esmolol infusion as an adjunct to propofol can affect BIS index.reduce anesthetic dose and decrease emergence time.Method Sixty ASA Ⅰ～Ⅱpatients,age 18-35,undergoing uterine dilatation and curettage surgery were studied.They were randomized into two groups.Before induction,patients in esmolol group(Group E)were received 1 mg/kg esmolol intravenously and followed by esmolol 150μg·kg-1·min-1 intravenous infusion;patients in group C received normal saline instead of esmolol. Fentanyl (1μg/kg)and propofol(2 mg/kg)were used as induction drugs. The change of BIS index,heart rate and MAP during operation;total amount of pmpofol;time when patients opened eyes and time when patients reached the standard for discharge from hospital were recorded.Results BIS and heart rate of Group C at 1,2,3 minute after surgery started,increased significantly compared with the time after induction and those in Group E(P<0.05).the time patients reached the score of discharging from hospital in Group C is longer than that in Group E (P<0.05).Conclusion Esmolol combined with propofol administering in minor ambulatory operations can control the increase of BIS index caused by surgical nociceptive stimulus.Meanwhile the combination could reduce the dose of sedatives and decrease anesthesia emergence time.

Objective To explore the role of intraoperative indocyanine green angiography(ICGA) in the bypass surgery for moyamoya disease(MMD).Methods Thirty-seven MMD patients were surgically treated and prospectively recruited.Intraoperative ICGA was performed with a surgical microscope with integrated ICGA technology.ICGA was performed 60 times in 37 patients.In each patient,upon the completion of anastomosis,a near-infrared light emitted by laser diodes was used to illuminate the operating field and the intravascular fluorescence recorded by an optical filter-equipped video camera.Assessment of vascular patency and occlusion were also investigated.The findings of ICGA were compared with those of postoperative DSA(digital subtraction angiography).Results In all cases,excellent visualization of cerebral arteries was achieved.The information provided by intraopemtive ICGA significandy changed the surgical procedures.ICGA was used to identify 2 nonfunctioning STA-MCA(superficial temporal artery-middle cerebral artery)bypasses and both could be revised successfully.In all cases the final findings of ICGA could be positively validated by DSA during the postoperative course.Conclusion As one kind of intraopemtive angiography,ICGA provides a reliable and rapid intraopertive assessment of bypass patency.ICGA has a high spatial resolution and it facilitates the identification of stenoses and obstruction at the anastomotic site or vascular obstructions.It is a helpful tool for the intraoperative evaluation of bypass patency.

Objective To investigate the recognition and approach of the hidden related vascular in hemifacial spasm patients during the operation of microvascular decompression.Methods The clinical records of 85 patients of hemifacial spasm were analyzed at our hospital.The hidden related vessel was found in 7 patients.REZ(root entry zone)was surrounded bry Teflon cotton slice to separate the vessel from REZ. Results There were 7 patients of hidden related vessel in 85 patients.And the related vessels were anterioinferior cerebellar artery and its branches.The symptoms became totally relieved after operation and there Wag no recurrence.Conclusion The microvascular decompression is an effectively treatment for hemifacial spasm patients.Searching for the related vessel(particularly hidden related vessel)is the most important part of the operation.An effective decompression of REZ is the key point of operation.

Objective To explore the diagnosis and microsurgical treatment of giant cell tumor (GCT)of skull.Methods The investigators reviewed the clinical features,operative approach and prognosis of 23 consecutive cases of CCT of skuli operated at our department between July 2000 and November 2008.Results Headache was the most common presenting symptom(86.96%)found among the patients with GCT of skull. Besides.the symptoms induced by the consequent lesions of Ⅱ-Ⅻ intracranial nerves were also commonly observed.The mean duration of symptoms was 29.3 months and the mean preoperative KPS(Karnofsky performance scale)was 76±6.Among these cases,10 tumors occurred in sphenoid bone,9 in temporal bone,3 in posterior fossa and l in frontal bone.Gross total resections were achieved in 6 cases,subtotal resections in 10 cases and partial resections in 7 cases.There was no operative death case.The follow-up data of 18 patients(78.26%)were collected with a mean follow-up duration of 35.5 months.All patients lived in normal postoperative life.Conclusion GCT of skull is a generally low-degree malignancy showing a local bone invasion mostly in sphenoid and temporal bones.

Objective To investigate the effects of cardiopulmonary bypass on neutrophils apoptosis and the expression of survivin.Methods Ten patients who scheduled for cardiac surgery under cardiopulmonary bypass were recruited as study group and 10 healthy volunteers as control.Blood samples were obtained before operation,at the end of surgery,and at 24 hours postoperatively.Neutrophils were isolated by density gradient centrifugation and its apoptosis were evaluated by fluorescent microscope and flow cytometry.The expression of survivin proteinum Was examined by Western blotting analysis.Expression level of survivin mRNA was detected by RT-PCR. Results The apoptotic rate of neutrophils decreased significantly at the end of surgery(P<0.01),and was still lower at 24 hours postoperatively than before operation(P<0.05).The expression ratios of survivin proteinum and mRNA were increased at the end of surgery(P<0.01),and decreased gently at 24 hours postoperatively but was still higher than before operation(P<0.05).Conclusion Cardiopulmonary bypass could inhibit neutrophils apeptosis and increase the expression of survivin.The decrease of neutrophils apoptosis Was correlated with high expression of survivin.

Objective To investigate the role of arthroscopy in the diagnosis of unilateral knee arthritis of unknown causes.Methods During December 2005 to February 2008,74 patients of unilateral knee arthritis of unknown origins were treated with arthroscopy.And magnetic resonance imaging(MRI) scans were performed for all of them before knee arthroscopy.The diagnosis was made by the synovial appearance in gross examination in arthroscopy combined with synovial pathology,synodal fluid analysis and clinical manifestations.Results Among these patients,71 cases were definitely diagnosed and 3 cases had unknown causes.Thirty-nine cases(52.9%)were of rheumatoid arthritis(RA),7(9.5%) of seronegative spondyloarthropathy(SPA),7 patients(9.5%) of septic arthritis,6 patients(8.1%)of RA coexisting gout arthritis,5 patients(6.5%) of gout arthritis,5 patients (6.5%) of tuberculosis of knee joint,1 patient(1.3%)of pigmented villonodular synovitis and l patient(1.3%) of multicentric reticulohistiocytosis.Conclusion Arthroscopy provides valuable diagnostic information in unilateral knee arthritis of unknown causes.RA is the major cause of unilateral knee arthritis of unknown causes.Synovial appearance in gross examination in arthroscopy,synovial pathology and crystals are helpful to make a diagnosis.

Objective To evaluate the feasibility and accuracy of thoracic pedicle screw fixation when assisted by a CT-based navigation system.Methotis A total of 102 thoracic pedicle screws inserted by a CT-based navigation system(n=24)(Group A)and 98 thoracic pedicle screws inserted by X-ray fluoroscopy (n=22) (Group B) were obsenred by postoperative CT scan.The accuracy of both series was compared.And the process of navigation was investigated.Results Among Group A,99 were of grade I (97.1%),3 grade Ⅱ and 0 grade Ⅲ;among Group B,88 were of grade I(89.8%),8 grade Ⅱ and 2 grade Ⅲ.One patient of grade Ⅲ had the intractable pain of chest and back.Neural damage Was not demonstrated.The difference was statistically significant(P<0.05).Conclusion A CT-based navigation system Can increase accuracy of thoracic pedicle screw fixation.

Objective To investigate the curative effect of treating infected nonunion with debridement and granulated caneellous bone autograffing in a one-stage procedure.Methods Between 1999 and 2005,38 cases of infected nonunion were treated with immediate granulated cancellous bone autografting after debridement.Results At a mean follow-up of 44months(range:12 to 93),33/38(86.8%)had an excellent outcome,5(13.2%)developed infectious recurrent and/or persistent nonunion(1 case with infectious recurrence and persistent nonunion).Two patients suffered refractttre after removing external fixator.Conclusion The success rate of treating infected nonunion with debridement and granulated cancellous bone autografting in one-stage is high.

Objective To explore the relationship of motor deficits of the lower extremities with the imaging features of malignant spinal cord compression(MESCCs).Methods From July 2006 through December 2008,56 successive MESCC patients were treated at our department.All were evaluated by magnetic resonance imaging and computed tomography and were scored according to motor deftcits Frankel grading on admission.Imaging assessment factom of main involved vertebrae were level of vertebral metastastic location,epidural space involvement,vertebral body involvement,lamina involvement,posterior protrusion of posterior wall,pedicle involvement,continuity of main involved vertebrae,fracture of anterior column,fracture of posterior wall,location in upper thoracic spine and/or cervicothoracic iunction.Results Occurrence was the same between paralytic state of MESCCs and epidural space involvement of imaging features.Multiple regression equation showed that paralytic state had a linear regression relationshiD with imaging factors of lamina involvement(X1),posterior protrusion of posterior wall(X2),location in upper thoracic spine and/or cervicothoracic junction(X7)of main involved vertebrae.The optimal regression equation of paralytic state(Y) and imaging feature (X) was Y=-0.009+0.639X1+0.149X2+0.282X.Lamina involvement of main involved vertebrae has a greatest influence upon paralytic state of MESCC patients.Conclusions Imaging factors of lamina involvement,posterior protrusion of posterior wall,location in upper thoracic spine and/or cervicothoracic junction of main involved vertebrae can predict the paralytic state of MESCC patients.MESCC with lamina involvement is more easily encroached on epidural space.

Objective To investigate the effects of ketamine pretreatment on cerebral edema following brain ischemia reperfusion injury in rats and assess the involvement of Aquaporin 4(AQP4) expression.Methods Sixty-two healthy male Sprague-Dawley rats weighing 220-250 g were randomly divided into 3 groups：sham operation group(group Sham,n=18);saline group(group Vehicle,n=22);ketamine pretreatment group(group Ketamine,n=22).The transient focal ischemia/reperfusion was induced by introducing a silicone-coated monofilament nylon suture from the right external carotid artery into the origin of the middle cerebral artery,removing it after 90 min.In group Ketamine,the rats were exposed to ketamine(5％,1 mg·kg-1·min-1)for 30 vain before suffered from cerebral ischemia.Similarly;in group Vehicle and group Sham,the animals received saline vehicle at the same time and infusion rate.After the neurologic exams were assessed at 24 h of reperfusion,the rats were sacrificed after anesthetized,and the brains were quickly removed.To estimate cerebral edema,the wet-dry ratio was measured.Western-blot was used to detect the expression of AQP4 in the border of the infarct region Results The neurologic function deficit was significantly serious in group Vehicle and group Ketamine compared to group Sham(P<0.01).Ketamine pretreatment tended to improve neurologic outcome,but there was no statistical significance.The wet-dry weight ratio and AQP4 expression increased significandy in group Vehicle and group Ketamine Ⅲ than those in group Sham(P<0.01).Compared with saline vehicle,ketamine pretreatment did not decreased the wet-dry weight ratio significantly.AQP4 expression in group Ketamine was not significantly different from group Vehicle.Conclusion Ketamine pretreatment did not seem to improve the neurologic deficit outcome and attenuate edema,which was involved in no change of AQP4 expression.

Objective To investigate the mechanism of protective effect of Xingnaojing and Xuesaitong injections on cerebral ischemic reperfusion injury in rats.Methods The focal cerebral ischemia & reperfusion model was established by middle cerebral artery occlusion(MCAO).A total of 152 male SD rats were randomly assigned into 19 groups:sham operated group,Xingnaojing group,Xingnaojing plus Xuesaitong group and control group according to different reperfusion durations:2,4,8,24,48,72 h.the meantime,rats in control group received the same ip dose of saline.The levels of SOD and MDA were detected.The number of apoptotic neurons was detected by terminal-deoxynucleotidyl transferase medicated nick end labeling(TUNEL).Results During ischemic reperfusion,the MDA content of brain homogenate increased while the SOD activity decreased(P<0.05).Xingnaojing could significantly inhibit the increase of MDA after cerebral ischemic reperfusion(P<0.05)and the decrease of SOD activity in rats.The changes of SOD and MDA were smaller in the Xingnaojing plus Xuesaitong group than those in the Xinnaojing group (P<0.01).The number of apoptotic neurons in the Xingnaojing group was significantly lower than that in control group(P<0.05).And the number of apoptotic neurons in the Xingnaojing plus Xuesaitong group was even lower than that in the Xingnaojing group(4、8 h:P<0.05,24,48、72 h:P<0.01).Conclusion The Xingnaojing plus Xuesaitong injection has protective function after cerebral ischemic reperfusion.

Objective To study the effect of homocysteine(Hcy)on the damage of blood-brain barrier,and the intervention of the compounded vitamin in rat.Methods 54 normal male SD rats were randomly distributed into three groups:①Control group;②Model group;and ③Intervention group.The level of plasma Hcy was detected with high performance liquid chromatography.The content of Evans Blue leaked out brain tissue was measured by colorimetry.The transcription of matrix metalloproteinase-2(MMP-2) mRNA was evaluated by RT-PCR Results The level of plasma Hcy,and the content of Evans Blue leaked out brain tissue and the expression of MMP-2 mRNA of model group were 32.2±1.3,6.67 4±0.54,0.372±0.088 respectively,all signitlcanfly higher than those of the control group(12.4±0.9,3.32±0.56,0.035±0.021.all P<0.01).The level of plasma Hcy,and the content of Evans Blue Ieaked out brain tissue and the expression of MMP-2 mRNA of the intervention group was significanfly lower than those of the model group(12.5±1.4 vs 32.2 ±1.3,3.42±0.45 vs 6.67±0.54,0.118±0.052 vs 0.372 4±0.088,P<0.01).Conclusions These results indieate Hcy could increase the permeability of blood-brain barrier,the mechanism may be activating the transcription of MMP-2 in rats.The compounded vitamin has a protective effect on blood-brain barrier via lowering the level of plasma Hcy.

Objective To investigate the effectiveness and mechanism of tissue engineering vascularized bone in repairing segmental femoral bone defects in rabbits.Methods,Thirty-two rabbits were randomized into two groups(n=16 each).A segmental and critical bone defect of 15 mm in length was made at left femur.In experimental group,the tissue engineering bone constructed from autologous bone marrow mesenehymal stem cells plus β-tricalcium phosphate(β-TCP)and vascular bundle was implanted into bony defect.In control group.there was no implantation of vascular bundle.Animals were sacrificed at 2,4,8 and 12 weeks post-implantation respectively.Histological observation was conducted to determine the process of new bone formation and remolding.The expression of vascular endothelial growth factor(VEGF) in new bone was measured by immunohistochemistry,real-time PCR and Western blot.Results As indicated by histological observations over time,new bone formation increased in both groups.It was better in the experimental group than the control group at the beginning of 4 weeks.The expression level of VEGF gradually decreased in each group after an initial rise.And the expression of VEGF was significantly higher than the control group after implantation at all time points and peaked at 4 weeks.Conclusion Tissue engineering vascularized bone accelerates bone repair in critical size defect model of femur in rabbit Implantation of vascular bundle can promote the secretion of VEGF.And VEGF is an essential mediator of both angiogenesis and ossification.

Transplantation and substitution of stem cells is an important part of regenerative medicine, and the use of magnetic nanoparticles to label stem cells and real-time dynamic monitoring by magnetic resonance is a very promising method for stem cell tracing [1-3]. We attempted to explore whether USPIO can be carried into human stem cells by modifying the surface of ultrasmall superparamagnetic iron oxide (USPIO) with Tat membrane-penetrating peptide, in order to find a new way for magnetic resonance tracing of stem cells.

A 57-year-old female was admitted to hospital due to left limb weakness for more than 40 days and right upper limb numbness, weakness and chill for 3 days. On December 23, 2008, the patient developed left limb weakness without inducement in the morning, and the corner of her mouth was deviated to the right. At that time, she was able to answer questions correctly, accompanied by headache and vomiting several times. Skull CT showed a large area of infarction in the distribution area of the right middle cerebral artery. The disease gradually became serious and the degree of consciousness disorder deepened.